In last two decades, the incidence of Cesarean Sections (deliveries through abdominal incision) has been constantly rising at a high rate. In the UK and other western countries, the average rate of deliveries by Cesarean Section is around 25% and continues to increase. A significant proportion of Cesarean Sections are performed during the second stage or when women are in late stages of labor. Along with these statistics, there is a rising trend in failed instrumental deliveries, thereby adding to this group of patients. There is evidence that a Cesarean Section performed in these circumstances is prone to higher complications for both the baby and the mother.
The mechanism of difficult delivery of the fetal head during a Cesarean Section is not entirely clear. However, it is clear that such situations rarely, if ever, exist in elective Cesarean Sections. It follows that the impaction of a fetal head is a manifestation of an advanced first stage, and much more likely, an event of the second stage.
Moreover, the impaction seems to be more likely when the second stage is unduly prolonged. A clinician has to decide in these circumstances whether to try an instrumental vaginal delivery or to perform a Cesarean Section. Therefore, some of these cases can exist due to a reluctance to perform an instrumental delivery. The increased use of Cesarean Sections and the reduction in instrumental deliveries has compounded this problem.
There is also an increased use of epidural analgesia in labor, often resulting in a prolonged second stage of labor due to the lack of a maternal urge to push. This could be another reason for impaction of the fetal head in the maternal pelvis.
The deeply engaged fetal head is likely to lead to difficulty in delivery during a Cesarean Section, often leading to a delay in uterine decision—the delivery interval resulting in hypoxic trauma to fetus. The degree of this trauma depends on the length of the delay. There is also a risk of direct injury to the fetus due to force used during the attempted delivery by the operator.
The use of an assistant to help in pushing the fetal head through the vaginal route has been also suggested. This technique can also cause direct trauma to the fetus and lead to delay in delivery. A higher rate of maternal trauma and infections has also been reported while using this technique. Use of the vacuum instrument recommended in this situation, also adds to delay in delivery of an already compromised fetus. Other techniques described are breech extraction, which is often difficult and traumatic unless the operator is familiar with it.
Extension of uterine incision is quite common when the Cesarean Section is carried out at a late stage of labor. An incidence of around 35% has been reported. This often leads to increased blood loss and a need for blood transfusion as well as a higher risk of trauma to the urinary tract during attempts to repair this.
Medicolegal risks of a second stage Cesarean Section are significant. The Royal College of Obstetricians and Gynecologists (U.K.) have suggested that there should be more experienced help at hand when such a situation arises (Sentinel Audit).
To address the above-mentioned problems in childbirth, it would be beneficial to have a device that can be used to assist an obstetrician in delivery of a fetus during a Cesarean Section. Such a device could be of substantial benefit to the patient and could also be used in the situation when a cord prolapse has occurred; thus allowing the fetal head to be pushed up, and thereby allowing more time to prepare for an emergency Cesarean Section.
Such an invention would also be useful when performing Cesarean Sections in premature or small babies, and could be novel when used for dislodging the fetal head, which is deeply wedged in the pelvic cavity, and to deliver fetus without undue delay and trauma that could be beneficial for baby.
Hence, there is clear need for a device, which can dislodge or push the head of the fetus up in the uterus and facilitate delivery in a non-traumatic or safe fashion.
The Present Invention is novel and relates to using such a device to assist surgeon in performing a Cesarean Section.